BACKGROUND The aim of this study was to define clinical evidence supporting that triple ruleout computed tomography angiography(TRO CTA)is a comprehensive and feasible diagnostic tool in patients with novel coronaviru...BACKGROUND The aim of this study was to define clinical evidence supporting that triple ruleout computed tomography angiography(TRO CTA)is a comprehensive and feasible diagnostic tool in patients with novel coronavirus disease 2019(COVID-19)who were admitted to the emergency department(ED)for acute chest pain.Optimizing diagnostic imaging strategies in COVID-19 related thromboembolic events,will help for rapid and noninvasive diagnoses and results will be effective for patients and healthcare systems in all aspects.AIM To define clinical evidence supporting that TRO CTA is a comprehensive and feasible diagnostic tool in COVID-19 patients who were admitted to the ED for acute chest pain,and to assess outcomes of optimizing diagnostic imaging strategies,particularly TRO CTA use,in COVID-19 related thromboembolic events.METHODS TRO CTA images were evaluated for the presence of coronary artery disease,pulmonary thromboembolism(PTE),or acute aortic syndromes.Statistical analyses were used for evaluation of significant association between the variables.A two tailed P-value<0.05 was considered statistically significant.RESULTS Fifty-three patients were included into the study.In 31 patients(65.9%),there was not any pathology,while PTE was diagnosed in 11 patients.There was no significant relationship between the rates of pathology on CTA and history of hypertension.On the other hand,the diabetes mellitus rate was much higher in the acute coronary syndrome group,particularly in the PTE group(8/31=25.8%vs 6/16=37.5%,P=0.001).The rate of dyslipidemia was significantly higher in the group with pathology on CTA while compared to those without pathology apart from imaging findings of the pneumonia group(62.5%vs 38.7%,P<0.001).Smoking history rates were similar in the groups.Platelets,D-dimer,fibrinogen,C-reactive protein,and erythrocyte sedimentation rate values were higher in COVID-19 cases with additional pathologies.CONCLUSION TRO CTA is an effective imaging method in evaluation of all thoracic vascular systems at once and gives accurate results in COVID-19 patients.展开更多
We read with interest the review by Teng et al,who summarized the current approach to the diagnosis and treatment of acute appendicitis(AA).Also,the article summarizes the clinical scoring systems very effectively.In ...We read with interest the review by Teng et al,who summarized the current approach to the diagnosis and treatment of acute appendicitis(AA).Also,the article summarizes the clinical scoring systems very effectively.In one of the previous studies conducted by our research group,we showed that the use of the Alvarado score,ultrasound and C-reactive protein values in combination provides a safe confirmation or exclusion of the diagnosis of AA.Computed tomography is particularly sensitive in detecting periappendiceal abscess,peritonitis and gangrenous changes.Computed tomography is not a good diagnostic tool in pediatric patients because of the ionizing radiation it produces.Ultrasound is a valuable diagnostic tool to differentiate AA from lymphoid hyperplasia.Presence of fluid collection in the periappendiceal and lamina propria thickness less than 1 mm are the most effective parameters in differentiating appendicitis from lymphoid hyperplasia.Although AA is the most common cause of surgical acute abdomen,it remains an important diagnostic and clinical challenge.By combining clinical scoring systems,laboratory data and appropriate imaging methods,diagnostic accuracy and adherence to treatment can be increased.Lymphoid hyperplasia and perforated appendicitis present significant diagnostic challenges in children.Additional ultrasound findings are increasingly defined to differentiate AA from these conditions.展开更多
BACKGROUND Total exposure to ionizing radiation has nearly doubled in the last two decades.This increase is primarily due to increased computed tomography(CT)exposure.Concerns have been raised about the risks associat...BACKGROUND Total exposure to ionizing radiation has nearly doubled in the last two decades.This increase is primarily due to increased computed tomography(CT)exposure.Concerns have been raised about the risks associated with patients'exposure to medical imaging radiation,which can increase a person's lifetime risk of developing cancer.Preventing unnecessary examinations becomes critical at this point.To avoid unnecessary examinations,it is necessary to understand the demanding process.AIM To ascertain clinicians'awareness of and reasons for requesting a CT examination.METHODS We developed an online questionnaire that included 20 questions about clinicians'awareness of radiation safety and their reasons for requesting a CT examination,as well as demographic information such as age,gender,and year of medical practice experience.Additionally,we asked participants the number of CT scans requested in a month,the patients'questions and approaches about the imaging method,the effect of the patient's previous imaging history on the current imaging request,whether they believed that they had sufficient information about radiation doses,and whether they requested CT without an indication.We administered the questionnaire to clinicians from a variety of different professions in four different cities.RESULTS A total of 195 clinicians participated.Internal medicine specialists were the most crowded group(38/195,19.5%).Mean age of the population was 33.66±5.92 years.Mean year of experience was 9.01±5.96.Mean number of requested CT scans in a month was 36.88±5.86.Forty-five(23.1%)participants stated that they requested CT scans without clinical indication.The most common reasons for CT scan requests were work load,fear of malpractice,and patient demand/insistence.CONCLUSION CT scan requests are influenced by a variety of factors,both internal and external to the doctors and patients.Raising awareness of radiation safety and reducing fear of malpractice by limiting the number of patients per physician may result in a reduction in unnecessary CT examinations and ionizing radiation exposure.展开更多
BACKGROUND Chronic otitis media(COM)is an inflammatory disease that lasts for a long time.It is common in developing countries.Hearing loss can result from COM.The relationship between variations in middle ear anatomy...BACKGROUND Chronic otitis media(COM)is an inflammatory disease that lasts for a long time.It is common in developing countries.Hearing loss can result from COM.The relationship between variations in middle ear anatomy and COM was investigated in our study.AIM To compare the prevalence of middle ear anatomic variations between the cases with COM and healthy individuals.METHODS This retrospective study included 500 patients with COM and 500 healthy controls.The presence of those variants was determined:Koerner’s septum,facial canal dehiscence,high jugular bulb,jugular bulb dehiscence,jugular bulb diverticulum,sigmoid sinus anterior location and deep tympanic recesses.RESULTS A total of 1000 temporal bones were examined.The incidences of these variants were respectively(15.4%-18.6%),(38.6%-41.2%),(18.2%-4.6%),(2.6%-1.2%),(1.2%-0%),(8.6%-0%),(0%-0%).It was observed that only high jugular bulb(P<0.001)and anteriorly located sigmoid sinus frequencies(P=0.002)in the case group were statistically significantly higher than the control groups.CONCLUSION COM is a multifactorial disease and variants of middle ear have always been important in terms of potential risk for complication during surgery but rarely associated with COM as an etiology or as a consequence of the disease.We didn't find a positive correlation between COM and Koerner’s septum and facial canal defect.We ended up with a significant conclusion with the variants of dural venous sinuses-high jugular bulb,dehiscence of jugular bulb,diverticulum of jugular bulb and anteriorly located sigmoid sinus-that have been studied less and frequently associated with inner ear illnesses.展开更多
The present letter to the editor is related to the study titled“Primary orbital monophasic synovial sarcoma with calcification:A case report”.Orbital synovial sarcoma is one of the rare intraorbital masses seen in a...The present letter to the editor is related to the study titled“Primary orbital monophasic synovial sarcoma with calcification:A case report”.Orbital synovial sarcoma is one of the rare intraorbital masses seen in adult and pediatric populations.Some case reports in the literature revealed that synovial sarcoma may contain calcifications.Therefore,it is important to make differential diagnosis among calcified orbital masses in childhood.展开更多
BACKGROUND Magnetic resonance imaging(MRI)with multiparametric dynamic contrast plays a critical role in the assessment of breast lesions.Dynamic curves are a critical parameter in determining the benign or malignant ...BACKGROUND Magnetic resonance imaging(MRI)with multiparametric dynamic contrast plays a critical role in the assessment of breast lesions.Dynamic curves are a critical parameter in determining the benign or malignant nature of lesions.Dynamic curves of type 1 are known to represent benign masses,while dynamic curves of type 3 are known to identify malignant masses.Type 2 dynamic curves have a sensitivity of 42.6%and specificity of 75%for malignancy detection.AIM To investigate the pathological diagnosis of lesions with type 2 dynamic curves.METHODS We evaluated breast MRI examinations performed between 2020 and 2021 retrospectively and included lesions with type 2 dynamic curves.We included 38 lesions from 33 patients.The lesions were evaluated for their pathological diagnosis and morphological characteristics.RESULTS Twenty-six lesions were malignant,while twelve were benign.The most frequently encountered benign lesion(7/12,58.3%)was sclerosing adenosis,while the most frequently encountered malignant diagnosis was invasive ductal cancer.The presence of a type 2 dynamic curve had a sensitivity of 40.2%and specificity of 73.4%for predicting malignancy.By combining type 2 curves and morphological features,the sensitivity and specificity were increased.CONCLUSION The high rates of malignancy detected histopathologically among patients with type 2 dynamic curves in our study are remarkable.Type 2 dynamic curves can be detected in benign breast masses,especially in sclerosing adenosis cases.Considering morphological features can increase the diagnostic accuracy in cases with type 2 dynamic curves.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)is a pandemic caused by the severe acute respiratory syndrome coronavirus in 2019.Although the real-time reverse transcription PCR test for viral nucleic acids is the gold ...BACKGROUND Coronavirus disease 2019(COVID-19)is a pandemic caused by the severe acute respiratory syndrome coronavirus in 2019.Although the real-time reverse transcription PCR test for viral nucleic acids is the gold standard for COVID-19 diagnosis,computed tomography(CT)has grown in importance.AIM To evaluate the sensitivity and specificity of thoracic CT findings of COVID-19 pneumonia according to age groups.METHODS PCR and CT results from 411 patients were reviewed.The diagnosis of COVID-19 pneumonia was made by three radiologists.Lymphadenopathy,pericardial effusion,pleurisy,pleural thickening,pleural effusion,location features of the lesions,ground glass,consolidation,air bronchogram,vascular enlargement,bronchial dilatation,halo finding,inverted halo sign,nodularity,air bubble,subpleural band(curvilinear density),reticular density,crazy paving pattern,and fibrosis findings were recorded.The patients were divided into nine groups by decades while calculating the sensitivity,specificity,and diagnostic efficacy for CT positivity.RESULTS The mean age of the cases was 48.1±22.7 years.The CT finding with the highest diagnostic power was ground glass.Vascular enlargement and bronchial dilatation followed ground glass.Pericardial effusion was the finding with the lowest diagnostic accuracy.The incidence of lymphadenopathy,pleurisy,pleural thickening,peripheral localization,bilateral,ground glass,vascular enlargement,bronchial dilatation,subpleural band,reticular density,crazy paving appearance,and fibrosis all increased increase significantly with age in patients with positive real-time reverse transcription PCR test.CONCLUSION There are few publications comparing sensitivity and specificity of thoracic CT findings according to age.In cases of COVID-19 pneumonia,there is an increase in the variety and frequency of CT findings with age,and parallel to this the sensitivity and specificity of the findings increase.COVID-19 cases in the pediatric age group have fewer lung findings than adults,and this situation decreases the diagnostic value of CT in pediatric patients.展开更多
Intrathyroidal ectopic thymus(IET)is defined as an ectopic thymus tissue that is generally found incidentally and rarely in the thyroid gland in the pediatric group.It occurs as a result of disruption of the embryolog...Intrathyroidal ectopic thymus(IET)is defined as an ectopic thymus tissue that is generally found incidentally and rarely in the thyroid gland in the pediatric group.It occurs as a result of disruption of the embryological migration path and the settling of the thymus tissue into the thyroid gland.In the differential diagnosis,it is mostly confused with thyroid nodules.Although thyroid nodules are less common in children than adults,the rate of malignancy is much higher.Therefore,knowing the general ultrasound findings of IET better may prevent unnecessary invasive attempts and surgical procedures.In this article,we tried to compile the key imaging findings of IET.展开更多
文摘BACKGROUND The aim of this study was to define clinical evidence supporting that triple ruleout computed tomography angiography(TRO CTA)is a comprehensive and feasible diagnostic tool in patients with novel coronavirus disease 2019(COVID-19)who were admitted to the emergency department(ED)for acute chest pain.Optimizing diagnostic imaging strategies in COVID-19 related thromboembolic events,will help for rapid and noninvasive diagnoses and results will be effective for patients and healthcare systems in all aspects.AIM To define clinical evidence supporting that TRO CTA is a comprehensive and feasible diagnostic tool in COVID-19 patients who were admitted to the ED for acute chest pain,and to assess outcomes of optimizing diagnostic imaging strategies,particularly TRO CTA use,in COVID-19 related thromboembolic events.METHODS TRO CTA images were evaluated for the presence of coronary artery disease,pulmonary thromboembolism(PTE),or acute aortic syndromes.Statistical analyses were used for evaluation of significant association between the variables.A two tailed P-value<0.05 was considered statistically significant.RESULTS Fifty-three patients were included into the study.In 31 patients(65.9%),there was not any pathology,while PTE was diagnosed in 11 patients.There was no significant relationship between the rates of pathology on CTA and history of hypertension.On the other hand,the diabetes mellitus rate was much higher in the acute coronary syndrome group,particularly in the PTE group(8/31=25.8%vs 6/16=37.5%,P=0.001).The rate of dyslipidemia was significantly higher in the group with pathology on CTA while compared to those without pathology apart from imaging findings of the pneumonia group(62.5%vs 38.7%,P<0.001).Smoking history rates were similar in the groups.Platelets,D-dimer,fibrinogen,C-reactive protein,and erythrocyte sedimentation rate values were higher in COVID-19 cases with additional pathologies.CONCLUSION TRO CTA is an effective imaging method in evaluation of all thoracic vascular systems at once and gives accurate results in COVID-19 patients.
文摘We read with interest the review by Teng et al,who summarized the current approach to the diagnosis and treatment of acute appendicitis(AA).Also,the article summarizes the clinical scoring systems very effectively.In one of the previous studies conducted by our research group,we showed that the use of the Alvarado score,ultrasound and C-reactive protein values in combination provides a safe confirmation or exclusion of the diagnosis of AA.Computed tomography is particularly sensitive in detecting periappendiceal abscess,peritonitis and gangrenous changes.Computed tomography is not a good diagnostic tool in pediatric patients because of the ionizing radiation it produces.Ultrasound is a valuable diagnostic tool to differentiate AA from lymphoid hyperplasia.Presence of fluid collection in the periappendiceal and lamina propria thickness less than 1 mm are the most effective parameters in differentiating appendicitis from lymphoid hyperplasia.Although AA is the most common cause of surgical acute abdomen,it remains an important diagnostic and clinical challenge.By combining clinical scoring systems,laboratory data and appropriate imaging methods,diagnostic accuracy and adherence to treatment can be increased.Lymphoid hyperplasia and perforated appendicitis present significant diagnostic challenges in children.Additional ultrasound findings are increasingly defined to differentiate AA from these conditions.
文摘BACKGROUND Total exposure to ionizing radiation has nearly doubled in the last two decades.This increase is primarily due to increased computed tomography(CT)exposure.Concerns have been raised about the risks associated with patients'exposure to medical imaging radiation,which can increase a person's lifetime risk of developing cancer.Preventing unnecessary examinations becomes critical at this point.To avoid unnecessary examinations,it is necessary to understand the demanding process.AIM To ascertain clinicians'awareness of and reasons for requesting a CT examination.METHODS We developed an online questionnaire that included 20 questions about clinicians'awareness of radiation safety and their reasons for requesting a CT examination,as well as demographic information such as age,gender,and year of medical practice experience.Additionally,we asked participants the number of CT scans requested in a month,the patients'questions and approaches about the imaging method,the effect of the patient's previous imaging history on the current imaging request,whether they believed that they had sufficient information about radiation doses,and whether they requested CT without an indication.We administered the questionnaire to clinicians from a variety of different professions in four different cities.RESULTS A total of 195 clinicians participated.Internal medicine specialists were the most crowded group(38/195,19.5%).Mean age of the population was 33.66±5.92 years.Mean year of experience was 9.01±5.96.Mean number of requested CT scans in a month was 36.88±5.86.Forty-five(23.1%)participants stated that they requested CT scans without clinical indication.The most common reasons for CT scan requests were work load,fear of malpractice,and patient demand/insistence.CONCLUSION CT scan requests are influenced by a variety of factors,both internal and external to the doctors and patients.Raising awareness of radiation safety and reducing fear of malpractice by limiting the number of patients per physician may result in a reduction in unnecessary CT examinations and ionizing radiation exposure.
文摘BACKGROUND Chronic otitis media(COM)is an inflammatory disease that lasts for a long time.It is common in developing countries.Hearing loss can result from COM.The relationship between variations in middle ear anatomy and COM was investigated in our study.AIM To compare the prevalence of middle ear anatomic variations between the cases with COM and healthy individuals.METHODS This retrospective study included 500 patients with COM and 500 healthy controls.The presence of those variants was determined:Koerner’s septum,facial canal dehiscence,high jugular bulb,jugular bulb dehiscence,jugular bulb diverticulum,sigmoid sinus anterior location and deep tympanic recesses.RESULTS A total of 1000 temporal bones were examined.The incidences of these variants were respectively(15.4%-18.6%),(38.6%-41.2%),(18.2%-4.6%),(2.6%-1.2%),(1.2%-0%),(8.6%-0%),(0%-0%).It was observed that only high jugular bulb(P<0.001)and anteriorly located sigmoid sinus frequencies(P=0.002)in the case group were statistically significantly higher than the control groups.CONCLUSION COM is a multifactorial disease and variants of middle ear have always been important in terms of potential risk for complication during surgery but rarely associated with COM as an etiology or as a consequence of the disease.We didn't find a positive correlation between COM and Koerner’s septum and facial canal defect.We ended up with a significant conclusion with the variants of dural venous sinuses-high jugular bulb,dehiscence of jugular bulb,diverticulum of jugular bulb and anteriorly located sigmoid sinus-that have been studied less and frequently associated with inner ear illnesses.
文摘The present letter to the editor is related to the study titled“Primary orbital monophasic synovial sarcoma with calcification:A case report”.Orbital synovial sarcoma is one of the rare intraorbital masses seen in adult and pediatric populations.Some case reports in the literature revealed that synovial sarcoma may contain calcifications.Therefore,it is important to make differential diagnosis among calcified orbital masses in childhood.
文摘BACKGROUND Magnetic resonance imaging(MRI)with multiparametric dynamic contrast plays a critical role in the assessment of breast lesions.Dynamic curves are a critical parameter in determining the benign or malignant nature of lesions.Dynamic curves of type 1 are known to represent benign masses,while dynamic curves of type 3 are known to identify malignant masses.Type 2 dynamic curves have a sensitivity of 42.6%and specificity of 75%for malignancy detection.AIM To investigate the pathological diagnosis of lesions with type 2 dynamic curves.METHODS We evaluated breast MRI examinations performed between 2020 and 2021 retrospectively and included lesions with type 2 dynamic curves.We included 38 lesions from 33 patients.The lesions were evaluated for their pathological diagnosis and morphological characteristics.RESULTS Twenty-six lesions were malignant,while twelve were benign.The most frequently encountered benign lesion(7/12,58.3%)was sclerosing adenosis,while the most frequently encountered malignant diagnosis was invasive ductal cancer.The presence of a type 2 dynamic curve had a sensitivity of 40.2%and specificity of 73.4%for predicting malignancy.By combining type 2 curves and morphological features,the sensitivity and specificity were increased.CONCLUSION The high rates of malignancy detected histopathologically among patients with type 2 dynamic curves in our study are remarkable.Type 2 dynamic curves can be detected in benign breast masses,especially in sclerosing adenosis cases.Considering morphological features can increase the diagnostic accuracy in cases with type 2 dynamic curves.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)is a pandemic caused by the severe acute respiratory syndrome coronavirus in 2019.Although the real-time reverse transcription PCR test for viral nucleic acids is the gold standard for COVID-19 diagnosis,computed tomography(CT)has grown in importance.AIM To evaluate the sensitivity and specificity of thoracic CT findings of COVID-19 pneumonia according to age groups.METHODS PCR and CT results from 411 patients were reviewed.The diagnosis of COVID-19 pneumonia was made by three radiologists.Lymphadenopathy,pericardial effusion,pleurisy,pleural thickening,pleural effusion,location features of the lesions,ground glass,consolidation,air bronchogram,vascular enlargement,bronchial dilatation,halo finding,inverted halo sign,nodularity,air bubble,subpleural band(curvilinear density),reticular density,crazy paving pattern,and fibrosis findings were recorded.The patients were divided into nine groups by decades while calculating the sensitivity,specificity,and diagnostic efficacy for CT positivity.RESULTS The mean age of the cases was 48.1±22.7 years.The CT finding with the highest diagnostic power was ground glass.Vascular enlargement and bronchial dilatation followed ground glass.Pericardial effusion was the finding with the lowest diagnostic accuracy.The incidence of lymphadenopathy,pleurisy,pleural thickening,peripheral localization,bilateral,ground glass,vascular enlargement,bronchial dilatation,subpleural band,reticular density,crazy paving appearance,and fibrosis all increased increase significantly with age in patients with positive real-time reverse transcription PCR test.CONCLUSION There are few publications comparing sensitivity and specificity of thoracic CT findings according to age.In cases of COVID-19 pneumonia,there is an increase in the variety and frequency of CT findings with age,and parallel to this the sensitivity and specificity of the findings increase.COVID-19 cases in the pediatric age group have fewer lung findings than adults,and this situation decreases the diagnostic value of CT in pediatric patients.
文摘Intrathyroidal ectopic thymus(IET)is defined as an ectopic thymus tissue that is generally found incidentally and rarely in the thyroid gland in the pediatric group.It occurs as a result of disruption of the embryological migration path and the settling of the thymus tissue into the thyroid gland.In the differential diagnosis,it is mostly confused with thyroid nodules.Although thyroid nodules are less common in children than adults,the rate of malignancy is much higher.Therefore,knowing the general ultrasound findings of IET better may prevent unnecessary invasive attempts and surgical procedures.In this article,we tried to compile the key imaging findings of IET.
